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The Sacrament of the Goddess is a great “beach read” for persons who want to be transported to an exotic time ( in the recent past) and place (on the far side of the planet from Boston).

It’s a way to learn the boots-on-the-ground of #Globalhealth and #globalsurgery without wading through a textbook. The story of working in a remote hospital in the Himalaya is told through the eyes of an international crew of medical volunteers working with a team of Nepali and Indian doctors.

Doing surgery is hard enough and it is not the usual experience to be around sick people every day. Taking your skills and offering them to people of another country during a civil war will take the challenge to a new level. Soon you are thinking about commitment, courage and sacrifice in a different way.

On page 178 of the novel, The Sacrament of the Goddess, there is a scene where the small group of doctors are assaulted by members of the family of a patient that died. The chowkidars of the hospital come running. There is a small “street brawl” but the hospital staff prevail. The attackers are subdued before permanent harm is done.

The event in the novel was chosen give the idea of how anger and frustration lead to violence in Nepal, and it is not the only example of collective action in the novel. Nepal is a “collective culture,” and any person who wants to study Nepali culture needs to grasp this idea.

Ram steadied himself against a shelf, red-faced and sweating as he regained his breath. “Never say for whom the bell tolls, Matt Sar. And now you see an ugly side of medicine in Nepal.”

“No kidding.”

Somewhere along the way,two hands had twisted the collar of Matt’s scrub shirt around his throat, trying to strangle him until his eyes bugged out. Now he had a headache. His clothes chafed and he was short of breath. Looking around, everyone looked like a rugby team resting during a time out. Even Sara took part in the jostling. She was at the sink, washing her face.

Matt heard protests from the corridor as the last men were escorted away.

“That was eleven against six. I am glad we outnumbered them. It is much easier,” said Ranjit.

Sara looked at Matt. “This – has been – a problem. Last year there was an assault at a hospital in Kathmandu, and the doctor received a skull fracture. The doctors of Nepal called for a nationwide bandh on medical care for one day.”

Then, “This could have been worse. A lot worse.”

Later Matt asks:

“And this is a Buddhist country?”

To read the answer the Nepali doctors gave Matt in the novel, you will need to read it for yourself. The climax of the novel takes place with another protest demonstration at the (fictional) hospital, and the team is challenged to find a way to survive the confrontation, as an angry mob of demonstrators gathers outside. I don’t want to spoil the ending, but – the entire plot of the book is designed to answer the question of how those doctors got there and what led up to the situation they faced, before presenting how the situation was resolved. These things do not take place in a vacuum.

This happens throughout Nepal but nobody talks about it

I wrote the novel because I had seen real-life events in which thrashing was meted out or threatened. I read every newspaper account of somebody getting thrashed. Starting in 2011 I was asked over and over what do to about doctors getting thrashed. In that year I began to teach de-escalation skills and situational awareness skills to nurses and docs in Nepal. At each class, nurses and doctors shared their stories of dealing with groups of people using violence to express themselves. Every reader of this blog is encouraged to find a nurse or doctor and hear for themselves about this. They will tell you. It affects all of us.

I myself wanted to understand how such violence could be woven into Nepali culture – the land of Never Ending Peace And Love. That’s why I wrote The Sacrament of the Goddess. On it’s surface it’s a love story – mainly so that readers would stick with it despite the challenging events of the plot. At a deeper level, it explores how group identity dictates the actions of the individual. The ending was intended to leave you guessing up til the last minute as to how it will end.

Violence as a means of expression in Nepal

This week in Nepal we all were shocked by the killing of seven police in Kailali during a protest in far-western Nepal. In particular, it was reported that SSP Neupane – the senior police guy on the scene – had told the Armed Police Force not to shoot just before he went to negotiate with the demonstrators. He was talking with the leaders of the demonstration and a man lunged at him with a spear. It seems clear that SSP Neupane was trying to avert violence. He was brave and heroic and he was filling the role of a senior guy in the police. Yesterday in this blog I shared my own observations of how the police operate in Terai. He deserves every honor given to him, as do his comrades. It is very sad that he failed.

When an angry person has a weapon it is indeed necessary for the Army to re-direct the situation, but he was trying to avert shooting. It was worth a try.

BBC Nepal posted an interview with Shanti Chaudhary, an activist from that region of Nepal, who pointed out the each police man killed, was a person who left behind family. This has also been true of the demonstrators in Terai, all along.

De-escalation

The initial reaction of many on the Twittersphere was anger and the desire to clamp down. The reaction from seasoned gurus was – don’t make things worse by responding with violence. If this was a terrorist act, the goal was to provoke the other side – the side of reason and discussion – into an over-reaction. For that reason, when the Army responds with overwhelming force, the terrorists get what they want.

De-escalation is the word for actions that bring the stress and anxiety down to a manageable level. De-escalation is what is needed now. De-escalation can only be provided when the central government decides to invite the demonstrators in Terai to a seat at a table where the issues can be discussed. De-escalation in my view, will only be achieved when those in power in Kathmandu begin to recognize the humanity of the people in Terai and accept the idea that Nepal is more than just Kathmandu. And amend the draft constitution so that the people of Terai are given a voice commensurate with their prominence in Nepal. The same goes for women and dalits.

In previous entries on the blog, long before this latest round of protests, I wrote about all the strategies to prevent violence and to de-escalate, focusing on small situations. It’s time now to expand those strategies to address violence throughout the country. I’m not saying that the killers should be allowed to go free – they need to be punished. But the strategy to find the criminals should be one that does not hurt innocent people with legitimate grievances.

August 23rd update: the news from Nepal is not good. In Kailali (an area of Terai) the police arrived to break up a protest and the protesters used weapons to kill police members ( differing reports – possibly five, possibly seven. One is too many). This has escalated as the days have gone on. Let’s all send good karma to Nepal and hope they can find ways to de-escalate. The best way is to engage in the political process, which includes listening to the demands and adjusting. There is no shame in compromise and dialogue!

My novel, The Sacrament of the Goddess, is the only novel that features an “andolan” as a main event; how it got started and how it affected the people swept up in it. The way that Nepalis conduct their lives as members of one group or another, is a fascinating subject and you can’t figure out Nepali life unless you have a handle on this idea. This appears at every level, not just the political. For example, in Kathmandu a pedestrian was killed crossing the street near Tri-Chandra College and the other students thrashed the driver and set his micro-bus on fire.

The RPP was holding small demonstrations all year but people said they were a fringe group. The are pro-monarchy, and want to bring an end to all Christian prosyletising in Nepal. This is a recipe for further trouble.

All this because the Constituent Assembly finally took action and put something on paper. For much of the time the political reporting was limited to gossip about the top leaders of Nepal but little else. Now, there is something on paper and people can react to that.

The odd part is that it was spurred on by the earthquake. Everyone could see the need to actually do something, to get a functioning government, so that Nepal could recover. Before long, everyone will long for the “good old days” when the Constituent Assembly did nothing.

This is not good for tourism

To recover from the earthquake, Nepal needs to show the international community that travel is safe and a vacation in Nepal can be “fun.” None of these events can be construed as “fun,” this is not attracting tourists to Nepal. As a foreigner, I am usually circumspect as to comments about the host country I love. But – could anything be more obvious? The vast majority of the country is unhappy with the way things are going.

I wrote the novel to explore the way that collective culture shows itself in Nepal. Specifically, there is a long-running problem in the health sector. If a patient dies, the survivors act out their grief through collective anger, and often the doctor gets thrashed, or the hospital gets vandalized by a mob of one size or another. This too, is not good for tourism.

In the news today, a massive landslide 8 km above Beni has blocked the KaliGandaki River, evidently creating a sort of earthen dam and temporary lake. Beni and other riverfront sites are apparently being evacuated. This is a breaking story.

A photo of the KaliGandaki riverbed below the blockage show that it is ominously low. Such a photo does not mean that the flow is gone; it means that it is accumulating. When the earthen dam releases, it will scour everything downstream with all of nature’s power. The height of the gush at release will be much greater than that caused by simple rain runoff. Much of Beni is on a spit of land – an alluvial flood plain.

The Sword of Manjusri is a symbol of cold hard logic applied to cut through any problem of any size. But – there are the legends…..

It should be noted that the Bagmati River that drains Kathmandu exits the Kathmandu Valley through a gorge at Chobar. When this thought came to me, I did not want to say it out loud, unleashing some kind of curse. Kathmandu is lucky that a landslide did not block the Bagmati at that location. Obviously, the likelihood of a landslide there is determined by the soil composition and height of cliffs above the Chobar Gorge; it is evidently composed of limestone, not soil. Unlikely to collapse suddenly. I am sure that the Nepal authorities must have evaluated this.

The legend of Nepal civilization is the Kathmandu Valley was once a huge lake, drained when Manjusri used his sword to create the Chobar Gorge. It that spot were to fill, Kathmandu would fill with water like a giant bathtub. Let’s pray that it doesn’t.

This is an impressive first novel which combines romance and Nepali culture and history in an easy-going, highly readable style. As an American physician who has visited Nepal numerous times doing teaching, public health research, and yes, toss in some trekking, I find the plot credible and the character development well done in the brief time allowed.

The history and cultural components are expert “teasers” enticing you to get a more in-depth exposure–ideally by going to Nepal! The religious discussions are very simplified, but again, will lead the reader to seek more data if interested. I

f you are planning to traveling to Nepal for the first time, this is good counterpoint to standard guides such as Lonely Planet. The medical discussions are appropriate and yet many Americans might find them difficult to believe, as they are harsh. Nepal is not a place fully appreciated by the naive, so take a little time to read this book before you go.When you get to Nepal, you can track down much denser historical, political, and religious tomes.Nepal continues to fascinate–and this book will give you some reasons why.

In Nepal, you can get this book at Vajra Books on Jyatha Marg in Thamel.

“It’s about the Civil War in Nepal and the missionaries caught in the middle;” or

“It’s about the way that medical decisions are made in a low income setting.”

Yeah, well, all the above are true, sort of. But the story is also about the way that people in Nepal deal with tragedy during those times when the doctors are unable to save somebody’s life.

“Thrashing” is a euphemism

And that’s where it gets interesting. The newspapers in Kathmandu always seem to publish stories about how this or that group of angry relatives “thrashed” a doctor, beating him (or her) senseless or creating a disturbance. When I first heard the term I thought it was “quaint.” Getting thrashed means that a mob beats you with bamboo sticks. If they are angry enough they can break every bone you have.

But there are even more stories that do not make the papers, and every doctor and every nurse is able to share the details of their own encounter with danger.

Young doctors dealing with fear

Young doctors in Nepal are trained at the larger hospitals, but after getting their MBBS degree, many of them spend a year posted in a rural health post, as a partial payment for student loans. If you ask them about this, their near-unanimous feeling is worry about trying to do the best they can, yet getting thrashed by angry family members if things don’t turn out perfectly.

If you don’t believe that this is a problem, read this report from Maharashtra State in India.

Finally, in the coming days, I will post a series of blog entries on the CCNEPal blog page, that will educate about strategies to deal with this problem. Click here to get to that blog, and when you do- click on the “subscribe” button. It will be a series you won’t want to miss. You will want to share it with your friends.